11-0966 (BLCK).P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X11-00000966 —
Property Address:
52830 AVENIDA MENDOZA
APN:
773-333-027-22 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2500
Applicant:
T4,ht 4 XP Q�&
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MICHELLE BELIN
52830 AVENIDA MENDOZA
LA QUINTA, CA 92253
Contractor: U
HENRY'S MASONRY, INC. v
P.O. BOX 5185
Date: 9/06/11
LA QUINTA, CA 92248 LL—
Lic.
SP 12 2011
(760)250-8253
No.: 704270 yO, FLA QUINTA
---------------------------------------------------------------------------------'----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am .licensed under provisions of Chapter 9 (commencing with —
Section 7000) of Division 3 of the Business ad Professionals Code, and my License is in full force and effect.
License Class: C29 License No.: 704270
e: U i onuactor:
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 fcommencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations: -
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code,'for the performance of the work for which this permit is
issued.
Y_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier HARTFORD INS Policy Number 41WEGPZ5043
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should coryE subject to the workers' compensation provisions of Section
� n/ 3700 of the Labor Cod/e, sh (forthwith comply with those provisions.
4a[e: /P I A icant: ✓
WARNING: FAILU EE TO WORKER�OST
ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENCIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THCOMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2., Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abo information is correct. I agree to comply with all
city and county ordinances and st to laws relating to buildin o ction, and hereby authorize representatives
of this county to enter upon t above-mentioned property r ' pection purposes.
at .� �gnature (Applicant or Agent):
Application Number 11-00000966
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check Fee
00
Issue Date . . . .
Valuation . . .
. 2500
Expiration Date 3/04/12
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25,000
9.00
------------------------------------------------------------
Special Notes and Comments
----------------
100 L.F. 6' GARDEN WALL AT REAR
PROPERTY
-LINE, CITY STANDARD. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.001.
Fee summary_ Charged
Paid Credited
Due
-------------------------------------
Permit Fee Total 54.00
--------------------
.00 .00
54.00
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 55.00
.00 .00
55.00
LQPERMIT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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Bin #
City of La nuinta
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Building 8r Safety Division '
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA. 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ��p
Project Address: ®�I �UJ�L`O7
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Owner's Name: �./'1r, Jr 111-4 f -
A. P. Number: -Sab J�gq� AUC V( il4,,
Address: /TtJe Ale
Legal Description:
City, ST; Zip: (J.'k)iS CA -L
Contractor:
!Y P711
Tele Phon e.
Address: golk P 6req t, -N -,
Project Description:
City, ST, Zip: S
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T ele P hone:—
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State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST; Zip:
Telephone:
hone:
................................:
Con strut tion T Y P e: Occu Pant Y:
State #
S Lic.
Project ct type (circle e one Neww Add'n Alter Repair e
D mo
Name of Contact Person:
Sq. Ft.;
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT.WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Tryss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted.
Grading
IN HOUSE:-
'"' Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P:P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
,. .